TrueBeam radiotherapy system is a multi-energy linear accelerator. Credit: Varian Medical Systems.
Developed by Varian Medical Systems, the device received FDA clearance in August 2021. Credit: Highlands Oncology Group.
The device provides image-guided stereotactic radiosurgery and radiotherapy for tumour and lesions treatment. Credit: Highlands Oncology Group.

TrueBeam is an advanced radiotherapy system developed by Varian Medical Systems, a medical device company based in the US, for delivering powerful and more accurate cancer treatments.

It is a medical linear accelerator that provides highly precise image-guided stereotactic radiosurgery and radiotherapy to treat tumours and lesions in various body parts, including lungs, breasts, head and neck.

The device received marketing approval in China in April 2011 and in Japan in June 2011. The US Food and Drug Administration (FDA) granted pre-market approval to the device for clinical use in August 2011. The device also holds a CE mark.

TrueBeam radiotherapy system design and features

The TrueBeam radiotherapy device consists of two main components: a beam-producing system for producing photon, electron and diagnostic X-ray radiation and a control panel.

The beam-producing system is installed in a vault in the healthcare settings to provide shielding from radiation, while the control panel that uses the device software is placed outside the treatment room.

The system is equipped with six rotational couches, a motion management interface (MMI) and a visual coaching device. Furthermore, it contains an entire Cone-Beam (CB) CT (CBCT) imaging suite, including 4D CBCT, gated CBCT imaging, short ARC CBCT, extended-length CBCT and multi-scan CBCT acquisition. Its sophisticated architecture integrates advanced imaging and motion management technologies.

Many tumours, such as those in the thoracic region, can move with a patient’s breathing. TrueBeam’s respiratory gating technology synchronises radiation delivery with the patient’s breathing, ensuring that the tumour receives radiation only when in the optimal position. It opens new avenues for treating lung, breast, prostate, head and neck, as well as other cancers.

The TrueBeam radiotherapy system has the ability to seamlessly integrate hardware, software, treatment strategies, safety measures, external solutions, pioneering innovations and comprehensive support.

This integration empowers care teams to harness transformative technology, fostering collaborative efforts that enable clinics to broaden treatment options, expand their reach and expedite novel healthcare initiatives.

TrueBeam radiotherapy system details

The system artfully harmonises various components, creating a seamless interplay that ensures unparalleled accuracy. Imaging, patient positioning, motion management, beam shaping and dose delivery come together in a well-orchestrated sequence that leaves no room for error.

Equipped with LaserGuard II, the device uses 2.5MV and 4MV to 25MV energy for operation. It also integrates the previously FDA-cleared Trilogy radiotherapy system and related accessories.

The kV radiation source features touchguards and a supplemental capacitive collision detection system (kV CCDS). It enables proximity detection along with a kV detector and positioning units.

The system includes various intelligent tools, such as HyperArc radiosurgery and RapidArc radiotherapy, allowing an advanced treatment option for cancer patients.

Treatment using TruBeam

Treatment using TrueBeam is a three-step process, which includes planning, treatment preparation and radiation treatment.

It starts with capturing intricate details of the tumour and its surroundings. These images serve as a map for the specialists to navigate and the experts devise a personalised radiation therapy plan accordingly.

This includes determining the precise doses of radiation, calculating the number of sessions required, selecting the optimal radiotherapy modality and designing an approach that minimises impact on healthy tissues.

For treatment preparation, the patients are positioned using specially moulded devices. The treatment area is carefully marked with permanent ink to guide the focus of the radiation.

The equipment is calibrated and aligned for motion monitoring. The parameters are meticulously adjusted to guarantee the utmost accuracy in radiation delivery.

In the radiation treatment phase, the radiation doses are delivered for a specific period in controlled doses. The TrueBeam STx linear accelerator rotates around the patient to deliver the radiation beams.  It delivers calculated radiation beams carefully, with shaped and reshaped beams in real-time, targeting the tumour from multiple angles. A cone-beam CT, a form of CT, is used to administer 25% less radiation.

TrueBeam accurately administers radiation by capturing images of the tumour, verifying its positional accuracy every ten seconds and making necessary adjustments to the radiation beams in case of any tumour position changes.

Details of the intelligent tools

HyperArc high-definition radiation therapy is an advanced solution for intracranial stereotactic radiosurgery (SRS). It is utilised by Varian’s TrueBeam and Eclipse platforms. It delivers the treatment with a single click of the panel and has pre-defined imaging waypoints for complex treatment.

RapidArc, also known as the Volumetric Arc Therapy (VMAT) radiotherapy technology, delivers a 3D dose distributed to an entire tumour. It has a high precision of less than two minutes. It uses 360° rotational gantry in single or multiple arcs for treatment delivery.

Gated RapidArc radiotherapy offers precise treatment for lungs and other tumours subject to respiratory motion. The innovation not only compensates for tumour movement caused by the patient’s breathing but is also seamlessly in a continuous rotation of the treatment machine.

The device also uses the iterative CBCT (iCBCT) technology, an improved form of the CBCT technology. It combines Acuros Computed Tomography Scatter (CTS), reduces scatter contribution and improves image quality.

The technology improves the visualisation of soft tissue of the pelvis, head and neck. The device also integrates the ARIA oncology information system and the Eclipse treatment planning system. This helps clinicians simplify and manage treatment planning.

Benefits of TrueBeam radiotherapy system

The TrueBeam radiotherapy system helps patients to heal in fewer sessions, such as one to five for a patient, compared to 20 to 40 sessions of conventional radiation therapy (dependent upon the type of tumour). Shorter sessions lower the risk of side effects in patients.

It is a fast and simple treatment that takes about two minutes for procedures that used to take 10 to 30 minutes.

Planned treatment can be customised and synchronised in real-time according to the patient’s condition during radiotherapy by dynamic imaging enhanced by the device’s 2D, 3D and 4D imaging capabilities.

The motion management interface allows clinicians to know the exact position of treatment delivery, thus improving the treatment’s precision and accuracy. The CBDT technologies allow for better imaging of moving targets such as lungs and abdomen, advancing breath-hold stereotactic body radiation therapy (SBRT) and extracranial radiosurgery.

The system can be used to provide various types of radiation treatments, including intensity-modulated radiotherapy (IMRT), SBRT and RapidArc radiotherapy.